Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy.
Dermatol Online J. 2022 Mar 15;28(2). doi: 10.5070/D328257396.
A 76-year-old man came to our attention for the presence of itchy skin lesions localized on the trunk. The patient had a nodular melanoma removed two years earlier. Because of metastatic pulmonary melanoma, he underwent a lung lobectomy and began adjuvant therapy with nivolumab. After six months of treatment, the patient reported the appearance of itchy lesions on the trunk that were diagnosed as eczema and successfully treated with systemic corticosteroids. Upon corticosteroid discontinuation, the eruption relapsed presenting with erythematous macules, tense blisters, and erosions on the trunk and limbs. The presence of linear deposits of IgG and C3 at the dermo-epidermal junction and high serum levels of anti-BP180 antibodies confirmed the suspicion of nivolumab-induced bullous pemphigoid. Treatment with 0.6mg/kg methylprednisolone and 200mg/day doxycycline as well as nivolumab discontinuation induced temporary remission. After tapering methylprednisolone to 16mg/day, the patient developed new blisters. Therefore, dupilumab 300mg every other week was added with progressive improvement while methylprednisolone was tapered down and withdrawn after four months. After six months the patient was still in full clinical remission. Many cases of conventional bullous pemphigoid have been treated successfully with dupilumab, which can also be used safely in cancer patients without inducing overt immunosuppression.
一位 76 岁男性因躯干部位出现瘙痒性皮肤病变而就诊。该患者两年前曾因结节性黑色素瘤而接受手术切除。由于患有转移性肺黑色素瘤，他接受了肺叶切除术，并开始接受纳武利尤单抗辅助治疗。治疗六个月后，患者报告躯干出现瘙痒性病变，被诊断为湿疹，并成功接受全身皮质类固醇治疗。皮质类固醇停药后，皮损复发，表现为躯干和四肢的红斑性斑丘疹、紧张性水疱和糜烂。真皮表皮交界处 IgG 和 C3 的线性沉积以及抗 BP180 抗体的血清水平升高证实了纳武利尤单抗诱导性大疱性类天疱疮的怀疑。使用 0.6mg/kg 甲基强的松龙和 200mg/天多西环素以及纳武利尤单抗停药诱导暂时缓解。在将甲基强的松龙逐渐减少至 16mg/天后，患者出现新的水疱。因此，每隔一周给予 300mg 度普利尤单抗，并逐渐减少甲基强的松龙的剂量，四个月后停用。四个月后，患者仍处于完全临床缓解状态。许多常规大疱性类天疱疮病例已成功用度普利尤单抗治疗，并且在癌症患者中也可以安全使用，而不会引起明显的免疫抑制。
